Provider Demographics
NPI:1790834356
Name:JOHNSON, LUISA SEGATO (PHD)
Entity Type:Individual
Prefix:DR
First Name:LUISA
Middle Name:SEGATO
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:LUISA
Other - Middle Name:SEGATO
Other - Last Name:BRAKENSIEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:5655 LINDERO CANYON RD
Mailing Address - Street 2:#621
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-4016
Mailing Address - Country:US
Mailing Address - Phone:805-370-8500
Mailing Address - Fax:818-889-6827
Practice Address - Street 1:5655 LINDERO CANYON RD
Practice Address - Street 2:#621
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-4016
Practice Address - Country:US
Practice Address - Phone:805-370-8500
Practice Address - Fax:818-889-6827
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10299103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALBCP10299Medicare ID - Type UnspecifiedASSIGNED FORMER NAME'91